The Rose House

     It is a simple consequence of God's natural order.  Independent Living Facility (ILF) Residents, over time, require increased "personal care" support.
     For many families, recognizing and responding to this increasing need is difficult.  Here are a few insights that may help when, as, and if you find that mom/dad need "Activities of Daily Living"" (ADL) assistance.

*  Most Residents try to "self care", well beyond their decline stages.  They either deny obvious deficiencies or contrive explanations for   self-neglect, or simply fail to remember self-care activities that, historically were routine.

*  ILF Residents avoid requesting support because they believe it will be an imposition on the facility staff, that they believe are overworked and underpaid.

*  Many Residents are keenly aware of the significant difference in care expense between Independent Living and Skilled Nursing Facility ()SNF) care, and avoid requests for support as to avoid family financial burden.

*  Almost all Seniors enjoy residence in a well managed ILF.  Virtually no seniors feel the same about Nursing Home residency.

*  In our experience only about  one-third of  ILF residents have undertaken some estate planning designed to minimize family expense arising from SNF parental care.  Most families know:
      
             that SNF costs are $60,000 to $80,000 a year
             that Medicare pays virtually none of this expense
             that only through Medicaid qualification can these costs be avoided
             that an individual must deplete assets to less than $2000 to Medicaid qualify
             many seniors are morally oppose to strategies to gain Medicaid eligibility

*  For many families, Medicaid eligibility is not an issue.  Seniors requiring support neither have, nor have every had, assets that would exceed Medicaid limits.  Indeed, in most SNF's more than 90% of the residents are Medicaid supported.

*  For those families where assets are being held by their "advanced seniors"  or where families with assets have failed to use estate planing techniques to technically destitute advanced age senior, or where families have chosen against welfare entitlements....there are some hard choices. 

*  Frequently families with assets, who wants best care for their "advanced elderly" conclude that $6000 monthly for care must surely be more comprehensive care than available for $2000 at a ILF.  Sometimes this is true, but rarely.  Bedridden residents, those requiring special apparatus to transfer, and disruptive dementia,are profile examples for which SNF may be required.  However, for many declining seniors, continued ILF residence with supplemental "personal care support" makes far greater sense, for two reasons.  First, virtually every senior instinctively prefers the autonomy and privacy of their "single family" residence.  Second, in almost all instances the supplemental "personal care cost" for "SNF comparable care" in an ILF is astoundingly less than the ILF/SNF cost differential....do you wonder why?

*  SNF's have an important place in our communities because only through Medicaid support can the overwhelming majority of seniors find care in their last years, and further as referenced there are some aging profiles where that the special care requirements if delivered as supplemental care in an ILF on a one-on-one private pay basis would exceed the cost of SNF care, but for most advanced seniors the it's just a $50,000 annual  premium for mostly buracratic overstaffing.

  If your family faces these "hard choices', we will be happy to share our substantial experience!